A 59-year-old woman presented with a two-week history of spontaneous gum bleeding and easy bruising. Her full blood count on admission showed pancytopenia with haemoglobin of 96 gm/L, total white cell count of 1.6 x 109/L (absolute neutrophil count of 0.26 x 109/L) and platelet count of 17.0 x 109/L. Peripheral blood film showed a few abnormal hypergranular promyelocytes present. Five days later she developed the above signs. What is the diagnosis? Answer: refer to page 72

(Refer to page 51) Answer: Spontaneous bilateral periorbital haematoma associated with acute promyelocytic leukemia In this patient, the spontaneous bilateral periorbital haematoma could be due to severe thrombocytopenia. However the presence of abnormal promyelocytes in the peripheral blood smear (Panel, darkly stained cells are promyelocytes) is suggestive of acute promyelocytic leukemia (APL) which should be confirmed with a bone marrow biopsy, cytogenetic study for t(15;17) and molecular study for PML-RARa oncogene fusion.